Active NPI
Terrence A Doherty, MD
- Family Medicine Physician
- Old Lyme, CT
National Provider Identifier
1255435558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 029476
- Practice address
- 19 Halls Rd
Old Lyme, CT 06371-1457 - Phone
- (860) 434-8300
- Fax
- (860) 865-2388
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 029476 | CT | Primary |
Addresses
Primary practice location
19 Halls Rd
Old Lyme, CT 06371-1457
Mailing address
447 Montauk Avenue
New London, CT 06320
Phone (860) 447-1426
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1294769 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110428000020 | CT | Practitioner - Family Practice | 0345425781 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Temple University School of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeast Medical Group Inc
Practice addresses (Care Compare)
19 Halls Rd
Old Lyme, CT 06371-1457
Phone (860) 434-8300
95 Armory Rd
Stratford, CT 06614-1702
Phone (203) 384-3388
Hospital & facility affiliations
- Yale New Haven Health - Health at Home Southeast
- Visiting Nurses of the Lower V
- Masonicare Home Health & Hospice, Inc
- Lawrence & Memorial Hospital
- Yale-New Haven Hospital
- Middlesex Hospital
- Westerly Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 86.54
- Promoting interoperability
- 99.98
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029476 | CT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Current | Accepting new patients |
Locations
19 Halls Rd
Old Lyme, CT 06371
Phone (860) 434-2509
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Interoperability endpoints
- tdoherty187133@direct.ynhh.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- New London, CT
- NPI 1073530879
Hospital
-
- General Acute Care Hospital
- New London, CT
- NPI 1700092459
Hospital
-
- Home Health Agency
- Wallingford, CT
- NPI 1710976220
-
- Home Health Agency
- Waterford, CT
- NPI 1265490940
-
- Home Health Agency
- Centerbrook, CT
- NPI 1508872151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512691200000",
"number": "1255435558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "447 MONTAUK AVENUE",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "06320",
"telephone_number": "860-447-1426",
"fax_number": "860-447-0348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 HALLS RD",
"city": "OLD LYME",
"state": "CT",
"postal_code": "063711457",
"telephone_number": "860-434-8300",
"fax_number": "860-865-2388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "TERRENCE",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-08",
"last_updated": "2017-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CT",
"license": "029476",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1294769",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Old Lyme, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.